Introducing nerve-sparing approach during minimally invasive radical hysterectomy for locally-advanced cervical cancer: A multi-institutional experience

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Abstract

Objective To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC). Methods Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups. Results Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009–2010 to 97% in the year 2015–2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH. Conclusions The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.

Original languageEnglish
Pages (from-to)2150-2156
Number of pages7
JournalEuropean Journal of Surgical Oncology
Volume43
Issue number11
DOIs
Publication statusPublished - Nov 1 2017

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Hysterectomy
Uterine Cervical Neoplasms
Pelvic Floor
Minimally Invasive Surgical Procedures
Survival
Length of Stay
Control Groups

Keywords

  • Cervical cancer
  • Laparoscopy
  • Neoadjuvant chemotherapy
  • Nerve sparing
  • Robotic

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{1d87e441cb634184a9b7708d21891424,
title = "Introducing nerve-sparing approach during minimally invasive radical hysterectomy for locally-advanced cervical cancer: A multi-institutional experience",
abstract = "Objective To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC). Methods Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups. Results Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7{\%} in the year 2009–2010 to 97{\%} in the year 2015–2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57{\%}) and 36 (43{\%}) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH. Conclusions The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.",
keywords = "Cervical cancer, Laparoscopy, Neoadjuvant chemotherapy, Nerve sparing, Robotic",
author = "Francesco Raspagliesi and Giorgio Bogani and Arsenio Spinillo and Antonino Ditto and Stefano Bogliolo and Jvan Casarin and {Leone Roberti Maggiore}, Umberto and Fabio Martinelli and Mauro Signorelli and Barbara Gardella and Valentina Chiappa and Cono Scaffa and Simone Ferrero and Antonella Cromi and Domenica Lorusso and Fabio Ghezzi",
year = "2017",
month = "11",
day = "1",
doi = "10.1016/j.ejso.2017.08.015",
language = "English",
volume = "43",
pages = "2150--2156",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
publisher = "W.B. Saunders Ltd",
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TY - JOUR

T1 - Introducing nerve-sparing approach during minimally invasive radical hysterectomy for locally-advanced cervical cancer

T2 - A multi-institutional experience

AU - Raspagliesi, Francesco

AU - Bogani, Giorgio

AU - Spinillo, Arsenio

AU - Ditto, Antonino

AU - Bogliolo, Stefano

AU - Casarin, Jvan

AU - Leone Roberti Maggiore, Umberto

AU - Martinelli, Fabio

AU - Signorelli, Mauro

AU - Gardella, Barbara

AU - Chiappa, Valentina

AU - Scaffa, Cono

AU - Ferrero, Simone

AU - Cromi, Antonella

AU - Lorusso, Domenica

AU - Ghezzi, Fabio

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objective To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC). Methods Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups. Results Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009–2010 to 97% in the year 2015–2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH. Conclusions The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.

AB - Objective To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC). Methods Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups. Results Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009–2010 to 97% in the year 2015–2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH. Conclusions The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.

KW - Cervical cancer

KW - Laparoscopy

KW - Neoadjuvant chemotherapy

KW - Nerve sparing

KW - Robotic

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